Patients With Severe Aortic Valve Stenosis and Impaired Platelet Function Benefit From Preoperative Desmopressin Infusion
| Autor: | Peter Quehenberger, Petra Zeidler, Eva Base, Bernd Jilma, Michael Spannagl, Beatrice Birkenberg, Hendrik Jan Ankersmit, Barbara Steinlechner, Michael Hiesmayr |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Aortic valve medicine.medical_specialty Time Factors Postoperative Hemorrhage Risk Assessment Severity of Illness Index Hemostatics Double-Blind Method Von Willebrand factor Aortic valve replacement Reference Values Internal medicine Preoperative Care medicine Humans Deamino Arginine Vasopressin Platelet Hospital Mortality Infusions Intravenous Desmopressin Aged Blood Platelet Disorders Aged 80 and over Heart Valve Prosthesis Implantation biology business.industry PFA-100 Aortic Valve Stenosis Middle Aged medicine.disease Survival Analysis Echocardiography Doppler Surgery Treatment Outcome medicine.anatomical_structure Aortic valve stenosis biology.protein Cardiology Female Cardiology and Cardiovascular Medicine business hormones hormone substitutes and hormone antagonists Follow-Up Studies medicine.drug |
| Zdroj: | The Annals of Thoracic Surgery. 91:1420-1426 |
| ISSN: | 0003-4975 |
| Popis: | Background Patients with severe aortic valve stenosis have a markedly reduced platelet function as measured by a prolonged collagen adenosine diphosphate closure time (CADP-CT) determined by the platelet function analyzer PFA-100. We hypothesized that such patients may benefit from desmopressin when they present with prolonged CADP-CT due to the specific action of desmopressin on von Willebrand factor (VWF) and CADP-CT. Methods In this double-blind, randomized placebo controlled trial, 43 patients undergoing aortic valve replacement (due to severe aortic valve stenosis with CADP-CT > 170 seconds) were given desmopressin 0.3 μg/kg or saline intravenously after induction of anesthesia. Measurement of CADP-CT, factor VIII activity, von Willebrand factor antigen, GpIb binding activity, ristocetin cofactor activity, collagen-binding activity, and multimers were performed after induction of anesthesia, one hour after desmopressin infusion, and 24 hours postoperatively. Results In the majority of patients, baseline values of von Willebrand factor related indices were normal, but increased one hour after infusion of desmopressin by 73% to 90% as compared with placebo. Selective loss of high molecular weight multimers was seen only in a minority of patients. The CADP-CT was greater than 170 seconds in 92% of screened patients, and desmopressin shortened CADP-CT by 48% versus baseline and reduced postoperative blood loss by 42% ( p Conclusions Prolonged CADP-CT indicates platelet dysfunction in severe aortic valve stenosis, and can guide the use of desmopressin as an effective prohemostatic agent in patients with severe aortic valve stenosis. |
| Databáze: | OpenAIRE |
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